Insurance & Financing

Ive been waiting since 12/23 to find out. After several mis-communications with BCBS ( who might I add is horrible! !!!), I finally was told today im approved!!!! Surgery is 2/24/15!!!! I start my diet nect Tuesday!

Any one had Medicaid united health care community plan any advice as far as paper work

Hello everyone ! So here is the deal I been dealing with anthem blue cross of Ohio for the last two weeks trying to get an answer on my precert but they keep giving me the run around...I have called the main nurse left several voicemails with no call back I have called everyday since the 4th and the rep keeps telling me it's still pending with no further updates or notes. My hospital which is tufts medical center ( I'm in MA but my job offers only out of state insurance) has also been calling on a daily bases with no reply. So my question is for those that may have this insurance how long did it take you ? I'm running out of time my surgery is scheduled for December 2…

One of the stipulations of my insurance (BCBS of AL) is that the qualifying BMI (35) has been persistent for 3 years. I called my PCP and got my weights from 2011-2014 and I have 1 weight that wouldn't qualify...all the others are no problem. The other part that sucks is that the low weight/BMI was from 2013, so if I can't get approved now, then it will be several years. I found this out yesterday and had the biggest pity party, complete with crying for a good 30 minutes lol. After I got my composure, I started trying to think of a solution. I am wondering if I went back further than 3 years that it would be enough to document my history. Would a letter from my PCP…

For those of you who are doing the 90 day weight loss regimen, what all are you doing? What kind of diet? What kind of exercise? Who is keeping track of it all for the insurance company?

The first meeting with my surgeon they gave me a date. Does that mean i am approved? That was the beginning of december. I finished all my testing this week and going back Wednesday Jan 7 and am sccheduled for the 26th

I need some advice. I called my insurance bcbs il and was told they saw no requirement for 6 months of documented diet (my bmi is 45). Has anyone been approved recently(2014) and if so did you have to do the 6 month diet first? Also when you paid your out of pocket did you have to pay the surgeon or physician? Sorry for the questions I'm new to this and anxiously trying to get my doc appointments in ☺

My surgeon's office called today to advise Cigna approved me. I'm too excited for words! I go in to pick my surgery date on Monday. I can't wait to be on the loser's bench! :-)

Has anyone gained weight during their program and still got approved by Aetna? I've gained weight and my last weigh in is this Friday I'm nervous I will get denied.

So my paperwork was submitted by my surgeons office on 01/06/2015 .. Insurance has confirmed that they have it ... still no response .. sooo frustrated! . Has anyone had to wait this long? .. My surgeon always told me how great of an insurance this was and now ... silence for three weeks!

All my paper work gets submitted tomorrow. I have a surgery date of Feb 9th if all gets approved. Has anyone gone through this with medical in California? Any info will be helpful! Thank you

Crossing my fingers. After six months of visits and paperwork it all comes down to this. Even got a date of 2/4 provided I get approval. So anxious!

Hello everyone, I have BCN of MI and I was approved with no issues, I had to do 6 months of supervision. I lost and gained 10 lbs or so. There was no WL requirement but I was sure when I went to checkup close to 6 months that I was down. I have since gained but my date is 3/25/14. I start my pre opp diet this coming Monday 3/10/14. I went through Beaumont of Royal Oak MI. As long as paperwork is turned in with data that says you need the surgery BCN of MI is no problem. I just wanted to share this info

I am so overjoyed. I received a phone call from the doctors office. They left me a message and basically just said they were calling about my approval. I immediately thought oh no…they need more information. By the time I got the message to call back, the doctor's office was closed. I immediately called the insurance company (AETNA) and the agent was very nice…told me about how successful her gastric bypass was from 2 years ago. I told her I was worried that I wasn't gonna get approved and she don't worry…YOU'RE APPROVED. The date she gave me for my surgery was March 24. How do they come up with the surgery date? Do they contact the hospital to find out the first…

Hi everyone. I started this process with highmark insurance but now my insurance will change to UPMC Jan 1st.. Wondering if anyone has UPMC and what their approval process was like? Thank you

Hi everyone. Learned today that Bcbs federal received my packet yesterday. 33 pages!! It's currently under review. Anyone have an idea how long it takes to get a decision? Gosh!! This is stressful!!

Waiting for insurance approval over the holidays really sucks because I never know if a working day is a real working day....have people taken days off to extend the holiday...so it's going to take longer for me to get approved? I brought a pair of jeans in my target size and have them hanging on my bedroom wall. I have cleaned the whole house and rearranged furniture to make the place more comfortable when I come home post-op. I have purchased supplies for the hospital and home. I got a batik kit for Christmas and am trying to occupy myself by teaching myself to batik. But most of all, I wait. I try to stay positive, and I wait.

Hello there, my surgery is tomorrow (New Years eve!) and I have been up all night worried that my insurance approval will be overturned because I have gained weight since the approval several weeks ago. The approval letter states "The information provided above is not a guarantee of coverage. Coverage is based on all the terms and conditions of your plan as well as eligibility at the time services are received." My Aetna plan requires a 90 day pre-surgery regimen, and states: "Records must document compliance with the program; the member must not have a net gain in weight during the program." I lost weight during the program, but gained 4 pounds after the approval…

http://obesitycoverage.com/tricare-weight-loss-surgery-requirements/ Such a great resource for finding out what your requirements are!!! Updated and true to fact.

Does anyone know how long it takes to get a response from BCBS of Mississippi? VSG Ready

I just found out today that my insurance, United Healthcare choice plus, doesn't require a supervised diet or psychological evaluation. They only require a bmi over 40 and a bariatric center of excellence. I feel so fortunate. Now I just have to get approved.

I thought I'd throw this out there for everyone. I've had BCBS for years and they are against Gastric/Bariatric anything. I was forced to switch to a new plan in December due to the affordable care act. My Premium was $161.00 a month. It went up to like $470. I had a $1000.00 deductible and found out that for $20.00 more I could get 0 Deductible, so I did that. I got my new packet in the mail and the ACA did get rid of a ryder that said nothing related to my back, neck or head would be covered. So I guess if I had a sinus infection, because its in my head/nose area, I'd have no coverage. So those are gone I had high hopes that the ACA would also get rid o…

So, after all the time I took to decide to do this surgery, I finally got the long process started with my current doctor and did an orientation and had an appt to meet with the surgeon. AND NOW....my husbands work decided to change the health care options they previously offered and in order for us to stay with Cigna we would be on a High Deductible Health Plan, paying A LOT more money that we don't have. So I think we are moving to Kaiser and hate Kaiser but to survive financially we will have to move to this new plan. What are your experiences with Kaiser, specifically Kaiser Fremont, Ca? What is their process? Do you have a specific doctor you would refer? I…

I have BCBS of Oklahoma. Has anyone had trouble getting approved? I am finishing my psych eval and my last weigh in on January 15th. I am praying I get approved. My BMI is 37.7 and I have fulfilled all other requirements. Has anyone worked with BCBS of Oklahoma?

So I got my letter of approval from my insurance. I wanted to know if there are any Tricare prime folks out there? My referral was submitted 12/26/14 and the approval was 12/31/14. How's long did it take your surgeon to get back to you?

It's the first month of a new year and I am ready to move forward with the Sleeve surgery. I've met with my surgeon, got my list of to-do's and have prepared myself for the self pay due to a lower BMI. As I was reading up on my employer's leave policy, I was shocked to learn that if I go on Short Term Leave, It will take all but 3 of my PTO days! This means I will have to go the next 11 months with only 3 available pto days There is no way I can manage this! I was really hoping to get my new year started off right with the surgery but man is this throwing a wrench in my plans!

Ok, y'all......I called this morning, answered all their questions, and I now have a case ,manager named Rebecca. Calling the surgeon's office in about an hour once they open. Here I go!!! praying for this so hard!!

Well I was approved by Cigna in 9 days after the doctor filed it. They say nothing about the hernia that my doctor says I have and wants to remove. Of course my life happens and I cant have it done till this month. I had to go to my best friends mom funeral and stay with her since the day before Christmas then her sister had a heart attack. Wasnt meant to be for 2014 but I'm ready to kick 2015's ass. Extra co pays deductibles or not!

First Post(of many I hope) I just decided to start this journey. My question is where do I start? Do I go to my primary Dr? Or should I contact a Bariatric center directly? The only thing I have done is called my benifit center and was told my insurance covers if deamed medically necessary. Any information will be greatly appriacted. Thanks Delana

Stoke at young age of 19, Pre diabetic & BMI of 37. Hope I'm approved

I have colorado medicaid. Normally when I go to the dr.s office I have a $2 copay. Does anyone know what my inpatient copay ir surgery copay may be, or may even be around, just wondering what to expect, $0, $50, $100, $500?????? Thank you!

Ahhh so my insurance just switched over to bibs of TX federal. I called today abs said my husband's employer has an exclusion to bariatric surgery !!!! I've been doing everything for 6 months all of my apts, Egd, Nutritional counseling, physic evaluation. Thousands of dollars out of pocket down the drain. What do I do now!!!!

My first attempt at approval was a long, disappointing headache. We submitted to BCBS and they denied it saying I didn't have a co morbid when their criteria clearly stated BMI of 40 and greater or 35 and a co morbid. At the time mine was around 50. We appealed and proved our case but they then admitted I was a candidate but denied it due to administrative error. There were no errors. The next option was a state fair hearing which we pursued to get the run around. By this time it was open enrollment so I switched to WellCare. During all of this I finished the 6 month diet because BCBS only required 3. My insurance started the 1st of January. My doctors office submitted my…

Sent mine to insurance on the 1st and called them on the 3rd just to make sure they had received it and they had. This is the second time to be sent in the first time it was denied because they said I did not have the 6 months in for pcp visits and that was the only reason. However, I am afraid they will find another reason since I have met all my deductibles this year. Has anyone ever been denied the second time with insurance? Any reply would de appreciated so worried about this!!!!

I have Blue Care Network of Michigan insurance. I'm trying to get my psych eval scheduled. Does that fall under the Weight Reduction category or does it fall under Psychological Services?

You know what that means! I now have a group number, and a member number, and a PHONE NUMBER to call to enroll in the bariatric program!! Wooot Woooot!!

Hello, my insurance only had 3 requirements 1) Meet BMI criteria 2) Use in-network providers and 3) give them 2-3 weeks to make a decision. I have met all those requirements, plus I have a medical necessity: type 2 diabetes and now insulin dependent. I adamently asked about any pre-criteria, i.e. physician-supervised diet, etc. I was told no, not with my plan. The same answer was given to the surgeon's office and they were also provided with a confirmation number regarding what was required. The bariatric center had me do the usual: psych eval, pulmonology, bloodwork, primary care letter, endoscopy, dietician, meetings, etc. When all that was completed and reports compi…

So excited that I finished my requirements and the paperwork is being submitted to insurance. This will be a great way to start off 2015. Keep your fingers crossed for me! Lean in '15!

I'm excited! Insurance company (BCBSTX) received paperwork today. Now the wait is on. What should I be doing now while waiting for approval? Should I begin purchasing anything or what? Once I am approved I will have to attend Bariatric University, endoscopy, and pre-op hospital visit.

I have finished my supervised diet and all seems to be in order. My new insurance became effective today, so my submission will be happening soon. All of a sudden today I flew into a panic: what if I get denied?? I know it sounds silly but I never really considered that I could do everything right and not get approved. I have Aetna, and I did not gain during my supervised diet, so I'm good on that front. My bmi is still over 40 with my loss so far, and I have no comorbidities. My biggest concern: my weight history. I needed to provide a 2 year history, and I know that in 2012 I weighed the least I have in a long time, after doing weight watchers for 2 years. I l…

Hi yaw! I was wondering if anyone has recently had surgury using tricare reserve select. I went online and read where you must complete the 6 month diet, have Comorbidities, etc, but then I read ehere people were getting the surguries within months?! I was wondering how your experience was and how hard it was to get approved. A little background about me 29, 3 kids, 335lbs, bmi of 57.5, only Comorbidities as of now is sleep apnea and depression.... how much of a fight do you guys think I'm in for ????

Anybody have bcbs of nc ... I had read somewhere that they had took off the 6 month supervised diet...today a friend who had bypass told me her dr office said that as of October of 2014 it would again be one of the requirements... Any info would be greatly appreciated!!

Help!! I have my first consultation tomorrow at Vanderbilt in Nashville for Gastric sleeve. I just found out TODAY that I have a $15k cap for all bariatric surgeries. I'm so confused what this will mean for me. I've read several posts about some people who had doctors that negotiated the price down and didn't have to pay anything out of pocket and others who ended up with a $60k bill because of the cap on their insurance. Any insight or advice out there? I would rather pay out of pocket than end up owing a ton of money due to a cap. Thanks!

For those of you who have AETNA, be careful about your weight gain. I have AETNA open access and I called the insurance company to verify because I was told previously that it was ok as long as there is no net gain at the end of my 3 months. WRONG! There cannot be any weight gain during your 3 month or 6 month weigh-ins with your PCP or surgeons office. You will be denied. Make sure you have lost weight each time you go in to weigh-in. With that being said make sure you know what your policy entails.

From the day of your initial consultation with your surgeon, to the day of surgery... How long did the entire process take? I'm just wanting to know what to expect realistically. I have to do a 90-day diet for my insurance (Aetna) but a friend of mine with the same insurance said it took her an entire 7 months with all the testing and whatnot.

So, I currently have Tricare Prime(west) and i got the ball rolling with Trying to get the Lap-band. We are Stationed in California on Vandenburg AFB. I brought it to my PCM's Attention that Weightloss Surgery Is sounding more and more Effective as im yo-yoing between diets. He went ahead and sent a referal and now im undergoing the Process. Im a 5'5 Female with a BMI of 43 when i weighted in at my Sugerons Office. My Surgeon Does the lapband but he Strongly recommends i get the Sleeve. At first i was so Set on getting the Band but now i believe my Surgeon has completely convinced me otherwise 3 months later. Things i have done to get the Ball-rolling with Tricare: -A…

I started the process in Nov 13, which required six months of a medically supervised diet and many hoops to jump through. My approval letter arrived on July 14th. I've since been to the bariatric center, gotten most of my lab work done, and have just started the opti fast diet as required by the surgeon. Out-of-pocket costs for the surgery, which the bariatric center required me to pay up front even though I don't have a surgery date yet, is around $850.00. That doesn't include lab work or the anesthesiology. Plus there was the cost of the Opti-fast--around $400.00. My BMI is 56, plus I have high blood pressure and a C-Pap. That probably made me a shoo-in.

Has anyone delt with BCBS Georgia before? How much was your total cost? I went on their website and it quoted me around $3500. That's allot different from what they told my husband over the phone. I thought most/all of it was going to be covered. Does this seem like an accurate total? I have an appointment on the 13th and I'm hoping it's not $3500.

I recently aged put of my parents private health insurance and am now self pay. Fortunately, I had my surgery - covered at % 100- exactly 8 days prior to losing that coverage. That being said, all had been communicated to my doctors and nothing was changed. I say nothing changed because AFTER my surgery, the doctor tells me I should have had a different procedure because the cost of maintenance is significantly less. Bottom line: If you will be self pay for whatever reason, talk to your doctor about the Long term financial costs of each bariatric procedure. One might be better if you don't have a financial commitment every 6-8 weeks, as with the band, when compare…

Hi everyone, long time lurker, first-time poster. Any thoughts or comments to my topic are certainly welcome. On the advice of my gastroenterologist and primary care physician, I began to explore WLS surgery in the summer of 2014. My 2014 insurance coverage specifically excluded WLS surgeries, etc. To prepare for the possibility of WLS surgery, I switched to a new plan offered by my employer that does cover WLS surgery. I called UHC today to find out details about the requirements for WLS surgery. What I was told: WLS surgery is covered if recognized by the NIH as effective for treating long-term morbid obesity. Specific surgeries mentioned by the rep (verbatim),…